Sever’s Disease (Calcaneal Apophysitis)


  • This is a transient condition that affects the calcaneal apophysis at the insertion of the Achilles tendon.
  • Usually in active children where inversion/eversion of the calcaneus causes a torsional effect on the apophysis.
  • In severe cases, there may be avascular necrosis.

Diagnostic tips

  1. Pain directly around the back of the calcaneus, especially when squeezed.
  2. Pain on exercise or stretching the Achilles tendon.
  3. Typically affecting boys aged 9-13.
  4. Limping.
  5. Walking on toes.

Tests and Imaging

  1. Clinical examination and a detailed history allow diagnosis.
  2. Xray is often inconclusive. Bone scan or MRI may be more conclusive, particularly in recalcitrant cases.

Immediate Treatment

  1. Activity modification to reduce or stop any activity that causes pain.
  2. Short term NSAIDs, such as ibuprofen.

Possible Referral

  1. Podiatry for stabilising orthoses (to limit inversion/eversion of calcaneus) and footwear advice.